First Report [1998]
Scientific Committee on Tobacco and Health
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Introduction

Overall about half of all persisting regular cigarette smokers are killed by tobacco. Even so many people continue to smoke and in 1996 in England 28% of adults were regular cigarette smokers1 and still about 30% of all deaths in middle age are caused by the habit. To ensure progress in the area of tobacco control and to inform future action, there is a need to keep under review up to date medical, scientific and behavioural information in this area, and therefore, in 1994, the Department of Health (DH) established the Scientific Committee on Tobacco and Health (SCOTH). SCOTH, assisted by the Technical Advisory Group (TAG), embarked on a programme of scientific review and appraisal of a range of important issues related to tobacco and health.

Nicotine Addiction

1.30  Over the past decade there has been increasing recognition that underlying smoking behaviour and its remarkable intractability to change is addiction to the drug nicotine. Nicotine has been shown to have effects on brain dopamine systems similar to those of drugs such as heroin and cocaine, and with appropriate reward schedules it functions as a robust reinforcer in animals. People seeking treatment for heroin, cocaine, or alcohol dependence rate cigarettes as hard to give up as their problem drug.

Factors Influencing Young People to Smoke

Parents and siblings

4.7  An OPCS enquiry, commissioned by the Department of Health, showed that young people whose parents smoke are twice as likely to smoke as children of non-smoking parents. It also showed that young people who perceive no parental disapproval are seven times more likely to smoke than young people who perceive strong parental disapproval; that young people with a sibling who smokes are up to four times more likely to be regular smokers than those whose siblings do not smoke; and that the effect of peer smoking is more pronounced with increasing age. A Royal College of Physicians working party report showed that the prevalence of smoking among young people is higher in those living with a single parent and is higher still if the lone parent is a smoker. It should be said that little is known about the relative contribution of family influences and hereditary factors to susceptibility to smoking.

The Effect of Smoking on Cognitive Performance and Mood

6.1.1  Many smokers claim that they smoke to alleviate boredom and fatigue, reduce tension, increase concentration and aid relaxation. Furthermore, it has been suggested that smoking confers psychological benefits and that a major motivation for many smokers is the use of smoking as a means of obtaining desired psychological effects, primarily enhancement of cognitive performance or reduction of negative influences such as anxiety, impulsive anger or other adverse situations.

Cognitive Performance

6.1.3  Results of a simple reaction time test showed that cigarette smokers have shorter reaction times than non-smokers or ex-smokers. No dose response effect among smokers was demonstrated. More sophisticated tests assessing choice reaction time, verbal memory and spatial processing showed no difference between smokers, non-smokers and ex-smokers. These results contrast markedly with the results of studies on caffeine intake, where a clear dose response is demonstrated. From these data it can be concluded, therefore, that nicotine has no clear performance enhancing effect.

Mood

6.1.4  Further data from the Health and Lifestyle Survey were considered in which adults completed the General Health Questionnaire, which is a measure of current psychological well being. Results showed that smokers felt worse than never- or ex-smokers and a clear dose response effect was demonstrated, with heavy smokers feeling worst of all.

6.1.5  Results showed progressive unhappiness with the number of cigarettes smoked and that the risk of current psychiatric disorder increased with increasing cigarette consumption.

6.5  Diseases with a Lower Risk in Smokers

6.5.3  With respect to Parkinson's disease, endometrial cancer and ulcerative colitis smoking exerts a protective effect which appears to relate to nicotine.

Technical Advisory Group

7.8  The role of nicotine in the pathogenesis of smoking related diseases is uncertain, although it is clearly implicated in the establishment and maintenance of the smoking habit. Nicotine yields in manufactured cigarettes are not currently controlled, but yields have tended to fall as tar levels have reduced and this trend needs to be maintained.

Tobacco Product Information and Regulation  

9.5  In the United States the Food and Drug Administration has recently been given authority to regulate tobacco as a drug. This raises important questions about possible action to regulate tar (or specific tar components), nicotine and gas phase emissions from cigarettes, as well as allowing competition on a more rational basis between the pharmaceutical industry and the tobacco manufacturers. Currently the pharmaceutical industry is strictly regulated in respect of preparations of nicotine and other novel nicotine delivery devices whereas the tobacco industry can launch a new cigarette with the minimum of controls. These issues need consideration in the UK, including the possible establishment of a regulatory authority to control nicotine and tobacco products.

Annex A

The Independent Scientific Committee on Smoking and Health

The previous Government advisory group on tobacco issues was the Independent Scientific Committee on Smoking and Health (ISCSH), initially formed to examine modifications to the smoking process and tobacco products. It met first in 1973.

 

Recommendations

The enormous damage to health and life arising from smoking should no longer be accepted; the Government should take effective action to limit this preventable epidemic.

The Government should require of the tobacco industry:

  1. reasonable standards in the assessment of evidence relating to the health effects of the product it sells,
  2. acceptance that smoking is a major cause of premature death, and
  3. normal standards of disclosure of the nature and magnitude of the hazards of smoking to their customers, comparable to that expected from other manufacturers of consumer products.

Young people, in particular, should be protected by a ban on all forms of tobacco advertising and promotion.

Price, advertising and promotion influence tobacco consumption. The real price of tobacco products should continue to be increased each year to reduce consumption. All forms of tobacco advertising, promotion and identifiable sponsorship should be banned.

Prevalence of smoking in the United Kingdom is increasingly associated with factors of social and economic deprivation.

The evidence that smoking relieves stress is weak; rather the reverse is true. In spite of widespread perceptions to the contrary, stress and anxiety are reduced rather than increased after giving up smoking. The public should be made aware of the association between smoking and negative mood states.

 

Key Messages

1   Active Smoking

Smoking is ... the most important cause of premature death in developed countries and accounts for one fifth of all deaths in the UK: some 120,000 deaths a year.
The enormous damage to health and the large number of deaths caused by smoking should no longer be accepted. The Government should take effective action to limit this preventable epidemic. The importance and urgency of the smoking problem needs to be recognised by both the Government and the public.
The Government should require of the tobacco industry a normal standard of disclosure and the recognition of the evidence that smoking is a major cause of premature death. Tobacco manufacturers should be required to inform their customers clearly and accurately of the nature and magnitude of the risks of smoking.

2   Passive Smoking

Passive smoking is a cause of lung cancer and childhood respiratory disease. There is also evidence that passive smoking is a cause of ischaemic heart disease and cot death, middle ear disease and asthmatic attacks in children. Restrictions on smoking in public places and work places are necessary to protect non smokers. Parents need to be informed about the effects of passive smoking on their children.

3   Nicotine Addiction

Addiction to nicotine is now known to sustain the smoking epidemic. Thirty five years after the first report by the Royal College of Physicians on Smoking and Health, nearly 30% of adults in the UK still smoke. Smoking in young adults is on the increase, leading to an overall rise in adult smoking prevalence in 1996 after 24 years of steady decline. Most smokers begin in their teenage years, at a time when the prospect of illness and death in adult life seems remote. Some eventually give up the habit, but for many the intractability of smoking behaviour reflects the fact that nicotine is a powerful drug of addiction.

4   Price and Advertising

Price and marketing are important factors in influencing cigarette consumption. Regular price increases above inflation will reduce consumption. Young people in particular should not be exposed to tobacco advertising or to the images associated with sports promotion and other forms of indirect advertising. These counteract public health messages, undermine a proper understanding of the real size of the hazard and promote the social acceptability of cigarette smoking. In view of the burden of disease and death caused by tobacco, there can no longer be any justification for the deliberate promotion of this habit, which is the most important cause of cancer in the world.

5   Smoking Cessation

Because of the time lag before onset of morbidity, the prospects for reducing smoking related disease in the next 20 years depend mainly on increasing the rate at which established smokers give up the habit. Policies to increase the price of cigarettes and to restrict smoking in public places are effective in encouraging many to quit, but smokers often find it difficult to overcome their dependence without help. Effective treatments to promote smoking cessation are available and need to be implemented in primary care, hospitals, pharmacies and other health settings.